It is worth noting that situations similar to those described in this medical malpractice case could just as easily occur at any of the healthcare facilities in the area, such as Kaiser Permanente, UCSF Medical Center, San Francisco General, California Pacific Medical Center, or St. Francis Memorial Hospital.

(Please also note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this personal injury case and its proceedings.)

On March 24, 2008, plaintiff returned to Dr. Hall for a follow-up visit. Plaintiff complained of pain when trying to walk without a splint. Dr. Hall noted an extensor lag when plaintiff attempted an SLR and also noted maltracking of the patella. Clinically, her knee was locking. Dr. Hall’s impression was patellar instability with subluxation. X-rays showed slipping of the prosthetic patellar component onto the lateral side. He advised plaintiff that unless her knee showed improvement, she should undergo a patellar revision and quadriceps repair.

Plaintiff next presented for a follow-up visit on April 14, 2008, complaining that her patella had drifted laterally. Dr. Hall recommended a revision patellar arthroplasty, and discussed with plaintiff the risks and benefits of the procedure. Plaintiff elected surgery.

On May 28, 2008, Dr. Hall, with Dr. Lee assisting, performed a quadricepsplasty and quadriceps realignment of the left quadriceps. A complete lateral release was carried out from the tibia proximally on the lateral aspect, which helped to control the mild tracking and subluxing, but did not completely settle the patella in its groove.

The lateral tibial patellar tendon was detached distally and woven through the patellar tendon into the medical tissues. The quadriceps repair was done with Ethibond and a double breasting, overlapping procedure, which was performed to tighten the medial structures. Dr. Hall noted this procedure may solve the patellar instability and its subluxation. Neither Drs. Lee nor Black observed any malrotation of the tibial tray. It did not appear to either doctor that the positioning of the prosthetic components were playing any part in the patella maltracking. Instead, their opinion was that a soft tissue component to the healing process was causing the maltracking. Accordingly, the lateral release procedure focused on addressing and rearranging the soft tissue. (See Part 5 of 8.)